title: Mesangial immunoglobulin (Ig)A glomerulonephritis in a patient with rheumatoid arthritis treated with abatacept.
abstract: We report observations of a 47-year-old seropositive woman with rheumatoid arthritis (RA) suffering from mesangial immunoglobulin (Ig)A glomerulonephritis (GN) after initiation of abatacept, a selective T-cell co-stimulation modulator cytotoxic T-lymphocyte antigen 4 (CTLA4)-Ig. She was initially treated by corticosteroids, followed by methotrexate associated with a TNF inhibitor (adalimumab then switched to etanercept), finally switched to abatacept monotherapy, after secondary failure of these two forms of TNF inhibitors. Due to a progressively increased hematuria and proteinuria after abatacept therapy initiation, a renal biopsy was performed highlighting GN with mesangial IgA deposits, with necrosis and extracapillary crescent formations. IgA GN as a possible adverse event to abatacept was considered. Abatacept was stopped and a treatment by corticosteroids was initiated. Proteinuria decreased a couple of months after abatacept interruption. The short term between abatacept induction and IgA GN onset, as well as GN improvement since abatacept discontinuation, lend weight to the argument that CTLA4-Ig may play a crucial role in IgA GN pathogenesis. The possibility of a drug postponed adverse event justifies a long-term renal surveillance in RA patients treated by abatacept.
authors.affiliation: Department of Rheumatology, University Hospital Centre of Caen, avenue de la Côte de Nacre, 14033 Caen cedex 9, France.
authors.forename: Murielle
authors.initials: M
authors.lastname: Michel
authors.forename: Patrick
authors.initials: P
authors.lastname: Henri
authors.forename: Fabien B
authors.initials: FB
authors.lastname: Vincent
authors.forename: Nathalie
authors.initials: N
authors.lastname: Leon
authors.forename: Christian
authors.initials: C
authors.lastname: Marcelli
mesh_terms: D000069594:Abatacept; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D005921:Glomerulonephritis / Q000139:chemically induced* / Q000276:immunology*; D006801:Humans; D018796:Immunoconjugates / Q000009:adverse effects*; D007070:Immunoglobulin A / Q000276:immunology*; D008875:Middle Aged
chemical_list: D018501:Antirheumatic Agents; D018796:Immunoconjugates; D007070:Immunoglobulin A; D000069594:Abatacept
keywords: Abatacept; Biological therapy; Cytotoxic T-lymphocyte antigen 4 (CTLA4)-Immunoglobulin; Glomerulonephritis; Immunoglobulin (Ig)A; Rheumatoid arthritis (RA)